Provider Demographics
NPI:1649683459
Name:BURNHAM, SHAWN R (HAD)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:R
Last Name:BURNHAM
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 MEADOWLARK WAY
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6882
Mailing Address - Country:US
Mailing Address - Phone:801-664-1856
Mailing Address - Fax:
Practice Address - Street 1:7359 267TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-4100
Practice Address - Country:US
Practice Address - Phone:360-386-3452
Practice Address - Fax:360-629-6554
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001401A237700000X, 237700000X
IDHA-2772237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist